This story has been updated with additional reporting.
Excessive call center wait times for callers to Oregon’s benefits help line may violate standards and cause low-income people to give up on trying to renew their health coverage, federal officials say.
The Centers for Medicare and Medicaid Services recently sent letters to officials in Oregon as well as 16 other states raising concerns about call center wait times. Nearly a quarter of phone calls from Oregonians seeking help renewing their Medicaid-funded Oregon Health Plan abandoned their calls and the average caller had to wait 15 minutes in May, according to the Aug. 9 letter, which also expressed concern about people enrolling for the Children's Health Insurance Program.
“CMS has concerns that your average call center wait time and abandonment rate are impeding equitable access to assistance and the ability for people to apply for or renew Medicaid and CHIP coverage by phone and may indicate potential non-compliance with federal requirements,” wrote Anne Marie Costello, a CMS deputy director, in the letter to Oregon Medicaid Director Dana Hittle.
States began reviewing their Medicaid rolls for eligibility in April after the federal government paused the routine checks for three years as a pandemic measure.
The Oregon Health Authority has aggressively touted its success in maintaining health care coverage for low-income Oregonians as it resumed the eligibility checks. State officials have laid out a phased 14-month process intended to preserve coverage as long as possible for the most vulnerable members of the Oregon Health Plan, which provides care for 1.5 million people.
But the letter suggests Oregon’s ongoing problems with its call centers could be causing some Oregonians to lose their coverage.
“Excessive call center wait times and call abandonment rates may signal barriers to the opportunity to complete an application or renewal for Medicaid and CHIP telephonically,” reads the letter.
Other states, however, had worse wait times. Missouri had the worst wait times based on May data. Callers waited an average of 48 minutes with a call abandonment rate of 44%.
In response to CMS making the letters public, Dave Baden, interim director of the Oregon Health Authority, defended the state’s efforts to the Associated Press.
“For sure it has been a challenge,” he said. “With the amount of humanity we’re going through, there’s no way we could have hired up so many people to be ready for all of that.”
Health authority spokeswoman Erica Heartquist told The Lund Report in an email that the agency staff "has been working very diligently on responses to CMS." She said calls seeking help with eligibility are the "main source of the longer wait times and abandoned calls, due to the increased call volume outnumbering our (full-time employee) capacity."
"We are aware of the increased wait times and abandonment rates at the call center and we are actively working with CMS to monitor the situation," she wrote
The concern is not new. The Oregon Capital Chronicle reported in April that callers had to wait on average 15 minutes to get help with eligibility requirements, sometimes having to wait an average of 30 minutes.
Wait times have gotten worse as redetermination continued
But despite the early concerns, the state’s dashboard shows that wait times have trended upward since Oregon resumed the eligibility checks.
The federal letter was based on data from May. The online state dashboard shows that on May 8 wait times reached a high for the month at the ONE Customer Service Center, where Oregonians can call for help with medical, food and other benefits. Callers waited an average of 22 minutes with 40% of calls abandoned.
Data reported to the federal government shows that Oregon’s call center saw 87,242 calls from people seeking help with Medicaid or the CHIP program, with an average wait time of 13 minutes for the month.
Since then, the spikes in wait times have trended upward at call centers overseen by the Oregon Department of Human Services. The average wait time rose to 17 minutes on July 10 with nearly half of calls abandoned. On Aug. 7, the average wait time was 19 minutes with 45% of calls abandoned.
The federal letter pointed out that people of color are more likely to rely on call centers because they lack access to the internet, as well as transportation and job flexibility needed to meet with staff in person. The long wait times may mean Oregon health officials are running afoul of federal requirements, according to the letter.
Heartquist said the call center upgraded its phone software on Aug. 18, which she said "may result in longer wait times for people applying for medical, food, cash and child care." She pointed to other ways people can get help with benefits, including visiting a local office, using a ONE online account or the mobile app.
In an email to health authority staff sent last week, Baden wrote that the state’s efforts to keep low-income Oregonians insured are paying off. He wrote that Oregon has completed eligibility renewals for nearly 662,000 people with just 12% losing their coverage. That puts Oregon among the top three states with the lowest rates of people losing their coverage during the eligibility reviews, he wrote.
Saying he’d just attended a conference of state Medicaid directors in Boston, he wrote that he’d heard praise from many of them. “In conversation after conversation, they are watching what we’re doing, and they’re impressed by our effort and our impact.”
Ellen Pinney, health authority ombuds, told The Lund Report in an email that she is pleased by the state's success in renewals, but “national accolades do nothing to address the concerns and anxiety I know so many clients feel about their health coverage.”
Pinney recommended that people worried about their coverage should create and monitor a ONE system account.
